Provider Demographics
NPI:1740396951
Name:SIMON, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:49 CASS ST S
Mailing Address - Street 2:SUITE1B
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-2331
Mailing Address - Country:US
Mailing Address - Phone:269-969-8920
Mailing Address - Fax:269-969-8921
Practice Address - Street 1:4870 W CLARK RD
Practice Address - Street 2:SUITE 202
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1104
Practice Address - Country:US
Practice Address - Phone:734-434-5430
Practice Address - Fax:734-434-5762
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI4301031929207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104241002Medicaid
MI104241002Medicaid
MIF33240Medicare UPIN